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Saturday, 7 January 2017

UK, NHS, Dorset: The Clinical Commissioning Group Consultation Document - and the future role of Dorset County Hospital.

Comments and observations on the NHS Dorset Clinical Commissioning Group Consultation
Document - and the future role of DorsetCountyHospital.

A lot of work went into the preparation of this formidable
48-page document, containing the proposals for changing the organisation of
local community and hospital-based services in Dorset,
and the enclosed 8-page consultation questionnaire.

I’m not sure I have the energy to fill in the tightly-structured
questionnaire, which asks for one box only to be ticked in answer to each
question, with allowable multiple choice responses from Strongly Agree to Strongly
Disagree, or “Don’t Know”.

The Commissioning Group has clearly decided what the
preferred options are (and will probably turn out to be). That’s what it seems
to me.

At the bottom of page 1 of the questionnaire, the group
writes: “Our preferred option is for 7 community hubs with inpatient beds;
and 5 community hubs without inpatient
beds but providing a range of outpatient and other service, spread throughout the localities in Dorset”.

“Doing nothing is not an option”.

Page 8: “We have difficulties staffing some services because
there are national and local shortages of some medical staff with key
specialist skills and it is difficult to recruit to some posts. This includes
GPs, mental health nurses, consultants working in accident and emergency and
paramedics. We also face the prospect that quite a lot of staff are coming up
to retirement age in the next few years. We are now trying to recruit staff
from other countries such as Portugal,
Spain, Italy, Ireland
and the Philippines.”

There is no mention
of all the uncertainties around the issue of the free movement of people,
following the referendum vote for Brexit and the possible outcome of
negotiations following the triggering of Article 50.

In the Dorset consultation
document (p. 11) it states that the vision for change includes the aim that
“more care would be delivered closer to home, reducing the need to travel”.

One of the main proposals (p. 12) is to provide “a different
way of providing urgent and emergency care services…so that we can save even
more lives and improve care”.

A major ‘option for change’ involves the creation of
“community care hubs” for outpatient
appointments (p. 17), an alternative to admission to acute hospitals
(p.19).

For Mid Dorset, the DorsetCountyHospital
in Dorchester would become a
community hub without beds (p.23).

That is confirmed on page 27: DorsetCountyHospital would be a
community hub without beds (but “also an acute hospital”). It’s not clear to me
how it can be an acute hospital and a
community hub without beds.

If “an acute hospital”, would it be a hospital for ‘moderately’
major planned care, or a (moderately) major emergency hospital?

Page 30: “We propose
that DorsetCountyHospital
would remain a district general hospital serving the west of the county and be
largely the same as it is now. However it would form part of a Dorset-wide set
of networked clinical services with Bournemouth and Poole.
The most seriously ill or injured patients needing specialist care would be
transferred to the major emergency hospital in the east of the county”.

The group’s proposals include two options for how acute
hospitals might be organised differently. Both options A and B include DorsetCountyHospital as a “planned and emergency care hospital” (page
31).

But on page 23 it is stated that DorsetCountyHospital would become a community hub without beds.

On page 32 it is states that 95% of Dorset’s population (the population being
defined as including all people whose nearest acute hospital is in Dorset -
meaning that a large part of the Dorset population might be nearer to Yeovil,
Somerset or a hospital in another county?) can reach services at Bournemouth
(as the major emergency hospital) within 30 minutes by blue light ambulance,
and that 90% of people can reach it
within 30 minutes “by peak time private car” (80% could reach Poole as the
major emergency hospital within 30 minutes by peak time private car). The
percentages might be considered a little misleading or skewed, given that the
major population centres in the county are in the Bournemouth and Poole areas, in any case. Isn’t 40-55 minutes a more
realistic peak time estimate for many people?

The consultation document points out (p, 32) that
“travelling times to the acute hospitals need to be considered…”

Bournemouth is the preferred option for future development
as the major emergency hospital, based on all the financial criteria (with Poole as the ‘planned care’ hospital).

This option also
allows for continuation of support to DorsetCountyHospital
as a “pivotal provider” for planned and emergency services in West
Dorset (page 33).

It is not clear to me what the group means by “a pivotal provider”, given some of the
ambiguous and contradictory statements of DorsetCountyHospital’s future role earlier
in the report.

Given the fact that those patients suffering from an
emergency such as a heart attack or a stroke need to be admitted to hospital
and treated within half an hour, thatamount
oftime being of the essence,
would a patient from the county town of Dorchester, let us say, or further
afield, be taken straight to Bournemouth, or to Dorset County Hospital?

Would the staff at DorsetCountyHospital have the
specialist training, support and equipment to deal with such life-threatening
emergencies?

A case study is provided on page 39. “Barbara is 75 and has
a stroke in the early hours of the morning at home in Puddletown”. The likely
scenario now is that she is taken by ambulance to DorsetCountyHospital, her nearest
local hospital. But upon arrival she is assessed and treated by the general emergency doctors who are available
on site.

Under the group’s proposals, Barbara would probably be taken
to Bournemouth, “where she would have access
to highly skilled, specialist staff 24/7”. Then “she would be transferred back
to her nearest local hospital as soon as it was medically safe to do so”.

But DorsetCountyHospital,
even if categorised as an acute hospital (albeit not a major one), is described
elsewhere as a community hub without
beds.

The big question
remains: could Barbara, or other patients, really reach the ward, and/or
receive specialist emergency treatment, at the RoyalBournemouthHospitalwithin 30 minutes? I ask again, isn’t
35-40 minutes travel time a more realistic peak time estimate?

Shouldn’t the preferred option be treatment at DorsetCountyHospital, with
properly-trained staff always on duty?

A final thought: if one hospital is designated as the major
emergency hospital for the whole of Dorset,
however much it is expanded or developed, won’t the queues for treatment and
waiting times at A and E quickly become unmanageable, leading, at worst, to the risk of 'black alerts'?

Campaigners hit out at hospital plans as Dorset CCG holds public consultation event in Bridport, Dorset Echo - 'David Jenkins, lay member of the Dorset CCG board, said: "We have been pleased with the number of people who have been good enough to give up their time at this event.
"I am very pleased that these proposals are for a general hospital with a high range of services to continue in Dorchester."Mr Jenkins also confirmed that talks were continuing between Dorset County Hospital and Yeovil Hospital to explore the possibility of working closer together".

So why is there no mention of Yeovil Hospital in the consultation document?

About the Dorset CCG Consultation document -

Maybe I’ve
misunderstood, or simply missed something…

I hope others will take the trouble to fill in this important questionnaire and return it before the deadline, by Tuesday 27th February 2017. You can also fill in the form online at www.dorsetsvision.nhs.ukI'll look at it again, although I feel I've raised some relevant queries, in the interests of both clarity and transparency.